| Doctor Name: | BENJAMIN OMAIYE |
| NPI Number: | 1063880037 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 95002343 |
| Business Practice Address: | 3680 E Imperial Hwy Ste 470 Lynwood, CA - 902622662 |
| Business Phone Number: | 3106043457 |
| Business Fax Number: | 3107626442 |
| Mailing Address: | 3680 E Imperial Hwy Ste 470, LYNWOOD |
| State: | CA |
| Postal Code: | 902622662 |
| Phone Number: | 3106043457 |
| Fax Number: | 3107626442 |
| NPI Enumeration Date: | 09/09/2015 |
| NPI Last Update Date: | 09/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 95002343 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |